For Referring Providers

Refer a patient to Mobile Health Providers

Fast, simple referrals. We handle insurance verification and scheduling, then keep you in the loop.

Insurance verified before scheduling

HIPAA-compliant intake

Step 1 of 3

About you (the referring provider)

Your name (required)

Facility or practice name

Provider phone

Provider fax (optional)

Provider email

Step 2 of 3

About the patient

First name

Last name

Date of birth

Patient phone

Street address

City

ZIP

Insurance type

Insurance ID If available

Step 3 of 3

Clinical details

Reason for referral (select all that apply)

Patient needs a PCP

Patient needs wound care

Other

Urgency

Routine Urgent

Additional notes (optional)

Attach records (optional — but the more, the better)

The more clinical records you can share, the faster we can process the referral and get the patient seen. Please attach whatever's available — facesheet, hospital records, H&P, med list, wound photos, and anything else relevant.

Attach clinical records Facesheet, hospital records, H&P, med list, wound photos — anything relevant. PDF, Word, or image; add as many as you need, up to 20 MB each.

Prefer email? Send records to info@mobilehealthproviders.com and reference the patient's name.

Your submission is HIPAA-compliant and secure

Patient information and any attached records are encrypted in transit and handled under our HIPAA policies. Referrals go only to our internal intake team.

256-bit TLS encryption PHI never logged Access-controlled intake

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Please fix the errors above. The highlighted fields are required.

This form transmits data over HTTPS/TLS encryption. All submissions are received by our internal MHP Pulse referral system.

Referral submitted

Thank you. Our team will follow up to confirm receipt and coordinate scheduling.

If this is urgent, please call 562-686-2015 or fax 562-381-9349.

Prefer to fax?

Download our PDF referral form and fax it to 562-381-9349.

Download PDF →

Prefer to call?

Speak with our intake coordinator directly.

Call 562-686-2015 →

Who refers to us

Built for the people doing discharge planning at 5pm on a Friday.

Facility teams

Administrators, EDs, DONs, and discharge planners at SNF, ALF, board and care, and independent living facilities use us for new admits with wounds and existing residents who need primary care without transport.

Home health agencies

When your nurses identify a wound that needs physician oversight or a patient who needs primary care at home, we partner with you on the clinical side.

Primary care & case management

Refer patients who cannot make it into the office, or who need specialized wound care while you continue managing the rest of their health.